OH Today Spring 2020

Partners of OH Today
CONTENTS
From the President 4
Self-Care for Healthcare
Workers
6
The Editor
The MTC and Rolls-Royce:
Innovation Through Adversity
8
Coronavirus Explained 12
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Return to the Front Line 18
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Production Editor
Hamish Pratt
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Published by iOH (Formerly AOHNP)
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Feeling Furloughed 24
A Day in the Life of a Flu
Outbreak
27
Interview: Lynda Bruce 29
Obituary: Lynn Faulds Wood 31
Hygiene in Spirometry 32
Supporting our clients and
caring for ourselves
34
2 OH TODAY
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OH TODAY 3

From the President
Lucy Kenyon
I can give a
first-hand
account of the
commitment
given by all
those working
not just on the
front line, but
across all
services
As I write for this special issue, I
reflect on my recent return to the
NHS to provide OH services. I can
give a first-hand account of the
commitment of those working not just on
the frontline, but across all services. OH
has a key role to play in occupational,
health, safety, wellbeing and welfare.
We are also back to my student days of
ward cleaners, where our housekeeping
staff are allowed to do a great job, rather
than carry out time and motion-based
tasks. Time is being taken to read ID
badges and everyone knows each other by
their first name.
I also discovered that the MTC were using
their research engineers to explore ways
to help the NHS. MTC have been working
with St Barts Hospital and the Royal
College of Anaesthetists to reduce the
risks associated with Exposure Prone
Procedures such as intubation.
On starting my NHS role, it became clear
that we needed to address rehydration of
front line staff who were wearing face fit
masks for hours. The MTC immediately
appointed a research engineer, Charlie, to
explore ways to develop new PPE with
integrated hydration packs which were
light enough to wear whilst carrying out
clinical procedures. He expanded his
research to look at face fit that would
cause fewer pressure areas on the face.
Such great innovation.
I am delighted to introduce this edition of
OH Today with efforts to improve life for
employees working during this unique
period in our recent history.
Lucy Kenyon and Neil Loach ⬛
OH Medical is aspecialistagency
that recruitsOccupational Health
and Wellbeing professionals
nationwide.
Wecan provideboth temporary
and permanent members of
staff at all levelsof seniority
and responsibility from
OH Technician, OH Nurse,
OH Advisorto OH Physician
info@ohmedical.co.uk
01582235500
www.ohmedical.co.uk
4 OH TODAY
OH TODAY 5

SELF
CARE
1 Stay hydrated.
While this may seem obvious, staying hydrated is
often a challenge for nurses. To combat dehydration,
take small sips of water throughout your shift.
Consider investing in an insulated tumbler to keep
beverages at the preferred temperature.
2 Take Breaks.
When you are busy with patients, it can be easy to
overlook your own needs. Making time for breaks
throughout your shift is important; a few quick trips
to the toilet can prevent unnecessary and painful
urinary tract and bladder infections.
By Neil Loach
Vice President of iOH and Senior
Lecturer at the University of Derby
3
Eat well, plan
healthy meals.
As a nurse, you may be burning through calories
faster than you think. You will need to frequently
refresh your energy reserves so make sure you have
healthy meals and snacks readily available. Avoid
relying on foods and drinks that contain high levels of
caffeine and sugar. Instead, select nutritious foods
that are portable and require minimal preparation.
4
Keep in touch with
friends and family.
Shift work and being on-call can wreak havoc on your
personal life. While it may be essential to pass on an
outing with friends or family at the moment,
maintaining these relationships virtually can do
wonders for your emotional health. Though you can’t
say yes to every invitation, strive to virtually meet up
with others outside of work at least once a day.
The country and world has endured weeks of unprecedented
challenge due to coronavirus. As we go further into the crisis, we
need to be mindful of how well healthcare workers may be
coping with the unprecedented way of caring for our most
vulnerable COVID-19 patients.
Neil Loach, Vice-President of iOH has
written the free e-book looking at
the ways in which healthcare
workers can take care of themselves, while
at the same time remembering to keep an
eye open for signs of distress in fellow
workers.
Neil said “I have a keen interest in the
psychological wellbeing of healthcare
workers and I’m a lifelong advocate for good
mental health among NHS staff after seeing
many worker referrals while in practice as a
Lead Nurse for Occupational Health within
the NHS”.
Using the work of Keith Carlson, an
American nurse and career coach, he has
adopted a nursing process approach, in the
hope that it resonates with healthcare
workers and creates familiarity. He has also
used his own photographs in the book as a
way of practicing his own mindfulness.
Opposite are some of Neil’s tips mentioned
within the book.
Download on Apple Books
https://apple.co/2y5QLcy
5
Use mindfulness.
Meditation techniques, like deep breathing and
guided imagery, can be instrumental in relieving
stress and refocusing on the present. With a growing
number of smart phone apps as well as meditation
videos designed solely for nurses, finding a suitable
format and style has never been easier. Mood selfassessment
tools are available and there are also
many apps available on your smartphone to assist
with this also.
7
Sleep is so
important.
Even if you are not working the night shift, creating a
relaxing sleep environment can ensure you get the
rest you need. Blackout curtains, eye masks, earplugs
and white noise apps on your phone can be helpful
options.
6 Exercise if you can.
Stamina and strength are necessary to perform your
job duties properly, and exercise can help. Find an
exercise you enjoy — whether it is walking, cycling or
yoga — and do it at least a few times a week. There
are plenty of free apps available that will help with
the current situation. When the gyms re-open there
are often discounts available for healthcare workers
that will then allow you to try out a few different
exercises and find what works best for you.
8
Be kind to
yourself.
Take time to remind yourself what an awesome job
you are doing. Be kind to yourself and rest assured
that you are not alone in this. Talk about how you are
feeling and seek the advice and guidance of your
managers and peers. You would do well to keep a
journal of your thoughts and feelings so that you can
reflect on them later. Remember, YOU are doing an
awesome job! ⬛
Background image by veeterzy/Pexels
6 OH TODAY
OH TODAY 7

INNOVATION
THROUGH ADVERSITY
By Rolls-Royce and the Manufacturing Technology Centre
How a team came together to develop a
shield to reduce exposure to COVID-19 in
healthcare workers undertaking Aerosol
Generating Procedures.
The COVID-19 pandemic has led to an
unprecedented response from UK
industry to support healthcare
workers and reduce the risk to their health
at work. From start-ups and small family
owned companies, to large multinational
corporations and Formula 1 teams, all
organisations are united in their shared
aim to support the NHS and healthcare
workers.
In just under a week, a team from
Rolls-Royce working with medical
specialists from the Royal London
Hospital and engineers at The
Manufacturing Technology Centre
(MTC) in the UK have developed,
tested and put a shield into clinical
trial. The shield has been
developed to reduce the exposure
to COVID-19 of front-line
healthcare staff undertaking
Aerosol Generating Procedures
(AGPs) without compromising
healthcare delivery. The fastmake
prototype activities were
supported with funding from
Innovate UK.
Evidence from previous viral
outbreaks suggests the initial
dose and the amount of virus
correlates with illness
severity. Healthcare workers
who undertake AGPs in
patients with COVID-19 are at risk of
exposure to high viral load due to these
procedures. AGPs are medical procedures
such as intubation. These procedures have
the potential to aerosolise the viral particles
found in the patient’s airway exposing the
healthcare practitioner to viral load, but also
causing contamination of the surrounding
environment.
From Concept to Design
The design concept was a shield for use in
AGPs to reduce the healthcare workers’
exposure. This concept was first trialled by a
doctor in Taiwan in early March 2020.
Medical specialists found that undertaking
AGPs on COVID-19 patients in full surgical
PPE inevitably took longer than usual. This
is due to the time involved in pre-procedure
preparation when time was of the essence in
many cases.
Dr Ian Renfrew, Consultant Interventional
Radiologist, with his medical colleagues,
sketched preliminary designs of a shield
which they provided to the Rolls-Royce
team, led by Andy York, to convert into an
engineering solution for clinical use. This
was the first time the MTC and Rolls-Royce
engineers had worked on an engineering
solution for the healthcare industry, as they
predominantly work together on projects for
the aerospace industry. ▶
8 OH TODAY
OH TODAY 9

The design requirements for the shield included:
• Visibility of the patient behind a physical barrier
with a flexible rear curtain that conforms around
the patient
• Multiple access points for assisted procedures
• Enough space for equipment required
• Access points for oxygen delivery
• Capable of being left in place after the procedure
to maintain containment without compromising
continued patient care
• Re-usable and easy cleaned using standard
hospital cleaning materials
• Minimal certification requirements to expedite
implementation
• Scalable
• Lightweight
The time from initial design to prototype concept and
production for bench trials was a day. Usually this
process would take at least a week.
Dr Ian Renfrew, Director of Interventional Radiology,
the lead medical specialist whose initial call
stimulated the request, commented:
“Great to witness the willingness of numerous
industrial partners uniting in the best example of
multidisciplinary working I’ve seen to bring the AGP
Shield to fruition. Thanks also to the early adopters in
over 30 hospitals whose feedback and contributions
are now creating a growing body of experience that is
being shared and documented.”
Design and Prototype testing
Using medical education equipment, from a teaching
hospital, the first prototype was tested at the MTC,
with guidance and input from doctors from the Royal
London, Coventry and Bridgend Hospitals, who joined
in person, recognising the current guidelines and
virtually. The engineers were taught to intubate using
medical simulation models. The team also focused on
the ergonomic aspects of undertaking AGPs including
the space required for the various items of equipment
needed during the procedure, tailoring the solution in
real-time.
With the results from the bench trials, further design
iterations were completed in collaboration with the
existing MTC production supply chain. This
was to enable small batch production suitable
for testing in a hospital or clinical setting. In
parallel guidance was sought from Medicine
and Healthcare Products Regulatory Agency
(MHRA) and BSI, the UK national standards
agency, on the categorisation of the shield.
Both organisations were supportive, and
the designs comply with their
recommendations.
Testing in a clinical setting
The shields produced in the first
production batch were distributed to
four hospitals, within a week of
initiating the project. The MTC/Rolls-
Royce team personally delivered each
shield, with usage and cleaning
instructions, backed up with videos
produced by the medical team
involved. This enabled each of the
four hospitals to quickly
implement staff training in
the use of the AGP Shield
and subsequent trial use in a
clinical setting.
Feedback from use of the AGP
shield in a clinical setting was
overwhelmingly positive with
a growing interest from other
hospitals. This resulted in a
growing demand to produce the
AGP Shield at volume from
within and outside the UK. The
team is
using this
ongoing
feedback to
make
further
improvements to the shield; the
latest design, which is 70% lighter
and stackable to enable
transportation and cleaning, is now
ready for dispatch. There are in excess
of 200 units in use across 30 hospitals
in the UK at present.
Performance assessment of
the AGP shield in a computer
simulation environment
The shield essentially creates a negative
pressure environment where local
extraction used in the procedure helps to
facilitate the rapid removal of airborne
particles including viral particles. ARUP,
who provide specialist services to the NHS,
performed computational fluid dynamics
(CFD) simulations in a 3D theatre
environment for the performance
assessment of the AGP shield. The CFD
simulations show a large (~85%+) reduction
in viral load exposure during AGPs. There
are plans to publish the results of simulation
testing of the AGP shield.
Manufacture
As previously highlighted, initial
manufacture was as a small batch utilising
the existing MTC production supply chain
capability. To scale production volume, the
MTC Team redesigned the AGP Shield to
enable manufacture using a variety of
techniques and materials, based on available
resources. The Rolls-Royce team engaged a
wider and larger supply chain network,
including Aston Martin’s Leather & Trim
team to support volume manufacture.
Andy York from Rolls-Royce commented
that: “All the staff from the MTC and Rolls-
Royce have been fully invested in modifying
the initial design to a now scalable,
lightweight model. This model can help
reduce risk to
the health of
clinicians such
as Ian and his
colleagues
while they
care for patients both in the UK and abroad.
The dedication and dynamism of the team
has been incredible. This is truly
multidisciplinary working and the best of
human kindness.”
Feedback from use of the AGP
shield in a clinical setting was
overwhelmingly positive with
a growing interest from other hospitals.
The MTC has open sourced fabrication
versions of the patented design and
manufacturing details on its website,
enabling global manufacture of the shield.
This coupled their own production capability
for direct requests for a one-piece
lightweight version of the shield, will help
reduce the exposure risk of healthcare
workers undertaking AGPs as they care for
patient with COVID-19 in their
communities.
The MTC have started work on customised
versions of the AGP shield for use in other
clinical settings beyond anaesthesia such as
dentistry and endoscopy.
If you are interested in understanding more
about the project and the MTC, and/or wish
to request an AGP shield or access the design
documents please visit the MTC website:
http://www.the-mtc.org/news-items/
intubation-shield-supporting-our-frontlinenhs-workers
⬛
Left: the
shield
developed by
Rolls-Royce
and the MTC
sitting on a
stand.
Images supplied by Rolls-Royce/Manufacturing Technology Centre.
10 OH TODAY
OH TODAY 11

The Government’s COVID-19
Recovery Strategy
Cutting through the information to
bring you an explanation
The UK government unveiled its
coronavirus recovery plan. The
government’s 50-page document,
called “Our Plan to Rebuild: The UK
Government's COVID-19 recovery
strategy” is split into three steps of lifting
restrictions. A new slogan has also been
unveiled, “STAY ALERT, CONTROL THE
VIRUS AND SAVE LIVES”.
The plan sets out the further lockdown
loosening at the start of June and further
changes potentially from 4 July.
• Major sports events to go ahead behind
closed doors.
• Those who can should work from home
‘for the foreseeable future’.
• Those in the food production,
construction, manufacturing, logistics,
distribution and scientific research
sectors should return to work from
Wednesday. Hospitality and ‘nonessential
businesses’ remain closed for
now until at least July.
On December 31, 2019, the World Health
Organisation’s (WHO) reported a previouslyunknown
virus behind a number of pneumonia
cases in Wuhan, Eastern China.
What started as an epidemic mainly limited to
China has now become a truly global
pandemic.
The disease has been detected in more than
200 countries with much of Europe and the
Americas experiencing the worst outbreaks,
forcing countries to announce restrictions and
lockdowns on citizens.
The UK has seen nearly a quarter of a million
confirmed cases and over 30,000 deaths as of
mid-May 2020. The true number of infections
and deaths is likely to be considerably higher.
In this feature we explore how the UK will
recover from COVID-19, risk groups, how the
threat will be monitored and the race for
effective treatments. ▶
The document applies to England only and
states that people must respect the rules in
Scotland, Wales, and Northern Ireland
when travelling there.
Prime Minister Boris Johnson said the plan
was “conditional and dependent as always
on the common sense of the British people.
What's in the 50-page
'roadmap' out of lockdown?
• People will be advised to wear face
coverings on public transport and in
enclosed spaces.
• Primary schools open for reception,
Year 1 and Year 6 from 1 June in small
classes. Key workers encouraged to
send their children to school.
• Up to six people from different
households will be allowed to meet
from 1 June.
• All nonessential
shops
can reopen on 15
June as long as
they are COVIDsecure.
▶
12 OH TODAY
OH TODAY 13

Measuring the
Threat
Plans to measure the threat from Covid-19 in England, has been
launched by the government with a new five-level, colour-coded
alert system. The prime minister says it will assist in deciding how
what social-distancing measures should be in place.
Level
Description
Aslevel 4 and there is a material risk
of healthcare services being overwhelmed
A COVID-19 epidemic isin general circulation;
transmissionishigh or rising exponentially
A COVID-19 epidemic isin
general circulation
COVID-19 ispresent in the UK, but the
number of cases and transmissionislow
COVID-19 isnot knownto
be present in the UK
Action
Social distancing measures
increase fromtoday’s level
Current socialdistancing
measuresand restrictions
Gradual relaxing of restrictions and
social distancing measures
No or minimal social distancing measures;
enhanced testing, tracing and monitoring
Routineinternational
monitoring
Screening for
COVID-19
PCR Tests
Polymerise chain reaction
(PCR) and antibody testing
are the main ways for
testing for Covid-19. Both
techniques have issues,
and researchers are
looking into alternative
ways to screen.
PCR tests detect the genetic information of the virus,
the RNA. They are only useful if someone is actively
infected. They detect the presence of an antigen, rather
than the presence of the body’s immune response, or
antibodies.By detecting viral RNA, which will be
present in the body before antibodies form or
symptoms of the disease are present, the tests can tell
whether or not someone has the virus very early on.
By scaling PCR testing to screen vast swathes of
nasopharyngeal swab samples from within a
population, public health officials can get a clearer
picture of the spread of a disease like Covid-19 within a
population.
Antibody Screening
The UK Government has approved a test that will
show if someone has had coronavirus in the past.
The new test - from Swiss pharmaceutical firm Roche -
looks for antibodies in the blood to see if a person has
had the virus and might now have some form of
immunity.
A reliable antibody test has been sought since the
beginning of the pandemic. Recently 3.5 million
antibody tests turned out to be ineffective.
It is expected that the test will be used initially for
health and social care staff.
An antibody test is already in use at the UK
Government research facility Porton Down. This test
will make estimates about the spread in the population
but it is not thought to be accurate enough to give
individuals information about their status of infection.
There is no that evidence people who have recovered
from COVID-19 have antibodies so they may be
reinfected.
What is the ‘R’?
R stands for “effective reproduction number”. The R value - often
referred to as R 0
or R-nought - refers to the average number of
people that one infected person will go on to infect in a population.
It is a measure of how transmissible, or contagious, a disease is -
but not how deadly.
An R value of one means the average person infected with the
disease will transmit it to one other person. This means the disease
is spreading at a stable rate. But an R of more than one means the
disease spreads exponentially. An R of less than one means the rate
of infections decreases so it will eventually die out.
Even if the UK’s R value for the new coronavirus is stable or even
dropping, modelling has shown that in most cases where lockdown
measures are lifted, the R value can quickly rise above one.
Who’s Most at Risk?
The Office for National Statistics,
ONS analysis shows that people
working in social care in England
and Wales have been twice as likely
to die with coronavirus as the
general working-age population.
But healthcare workers have been
no more likely to die than other
workers.
Nearly two-thirds of the 2,494 20-
to 64-year-olds whose deaths were
linked to Covid-19 were men.
And 63 were male security guards,
making them almost twice as likely
to die as even men working in social
care.
The study up to 20 April, factored
in age but did not take account of
people's ethnicity, location, wealth
or underlying health conditions.
It cannot yet prove the deaths were
caused by the jobs people do or by
other factors.
Ethnic minority males appear to
have an increase in the risk of
dying with Covid-19 if they have
other underlying health issues.
Specific male occupations had
noticeably higher death rates linked
to Covid-19, including:
• taxi drivers and chauffeurs
(36.4 deaths per 100,000)
• chefs (35.9)
• bus and coach drivers (26.4)
• sales and retail assistants
(19.8). ▶
Contains public sector information licensed under the Open Government Licence v3.0.
14 OH TODAY
OH TODAY 15

Test, Track and
Trace
The UK's "test, track and trace" strategy known
as contact tracing is being rolled with 25,000
new contract tracers including 3000 clinicians
being recruited.
Contact tracing is a well-established method
for controlling the transmission. The process
involves a person who is infected recounting
their movements and activities to build up a
picture of who else might have been exposed.
This is crucial with Covid-19 due to the highly
infectious nature of the virus, symptoms can
take several days to appear and people may be
asymptomatic, passing the virus on without
knowing it.
Health and Social Care Secretary Matt
Hancock says that implementation of a “test,
track and trace” approach will be key to
avoiding a second wave of infections.
“I think if we do test, track and tracing well
and we keep the social-distancing measures at
the right level we should be able to avoid a
second wave,” he said.
But, he said, there is a caveat. “Winter is going
to be extremely difficult when you also have
the flu circulating and you have all the other
respiratory infections which can get confused
with this.”
Contact tracing done by humans involves an
interviewer asking a person who is infected
where they have been and who they have been
in contact with. It is possible to get in touch
with those people who potentially have the
virus and ask them to be tested or self-isolate.
Residents in the Isle of Wight are currently
trialling a new contact tracing app. The NHS
Covid-19 app is intended to supplement
medical tests and contact-tracing interviews
to prevent a resurgence of Covid-19 when
lockdown measures are eased.
It will work by using Bluetooth
signals to detect when two
people's smartphones are near
each other. If one person later
registers themselves as being
infected, an alert can be sent to
others judged to be highly
contagious. This might be based
on the fact they were exposed to
the same person for a long period of
time or that there had been multiple
instances of them being in the
vicinity of different people.
The trial on the Isle of Wight will help
NHSX test the system, and to judge how
willing a population is to install and use
the app. An experiment was recently
conducted on an RAF base.
There have been concerns that this risks
hackers or that users may be able to reidentify
anonymised users. Concerns are
outweighed by the benefits of adopting a
centralised approach.
NHSX says that the app will help spot
geographical hotspots where the disease is
spreading and work out how to optimise the
app's algorithms to make its risk-model as
accurate as possible, which in should help it
decide who needs to be told to self-isolate or
request a test. It is also hoped that it will gain
new insights into how the virus spreads, such
as the degree to which transmission becomes
less likely the more time passes since first
symptoms
NHSX believes another major benefit is that
its app can make use of people self-diagnosing
themselves before they obtain test results.
The Rush to Find
Effective Treatments
Scientists around the world are working on
potential treatments and vaccines for the new
COVID-19 disease. Antivirals, blood plasma
transfers, plasminogen activators, stem cell
and immunosuppressants are amongst those
being investigated. We describe them briefly
below.
Antivirals
There are many companies developing or
testing antivirals against SARS-CoV-2, the
virus that causes COVID-19.
Antivirals target the virus and can help
people who already have an infection. They
work in different ways, sometimes
preventing the virus from replicating and
blocking it from infecting cells.
Remdesivir has been around for around
10 years and was found to show that its
use blocked the virus from replicating
in MERS. The FDA issued an order for
emergency use of Remdesivir despite
a recent study in the Lancet, who
reported that there were no
benefits compared to those on a
trial that were given a placebo.
Other drugs being trialled are
Kaletra, Favipiravir and Arbidol
but further research is needed
Blood plasma
transfers
The NHS require people who’ve
recovered from coronavirus (COVID-19)
to donate blood plasma, as part of a clinical
trial
The trial will tell us how effective
convalescent plasma (plasma from people
who’ve had coronavirus) is for treating
coronavirus patients.
If you have tested positive for COVID-19, or
you have had symptoms, you can help by
registering to donate plasma here.
Plasminogen Activator
Scientists at The University of Aberdeen
suggest an aerosol version of a ‘clot-busting’
drug called tissue plasminogen activator (tPA)
could help lung injury complications caused
by the virus.
The research, by Claire Whyte and Nicola
Mutch from the university’s Cardiovascular
and Diabetes Centre and honorary research
fellow Gael Morrow, has been published in the
Journal of Thrombosis and Haemostasis.
Similar diseases to COVID-19, such as
seasonal flu, can create inflammation which
results in deposits the protein called fibrin, a
major component of blood clots. The fibrin
build-up reduces the amount of oxygen the
lung can take in.
Oxford and Reading University and the Royal
Free Hospital in London are also backing this.
Stem cells
Stem cells appear to help some people with
severe COVID-19. A group of researchers has
used a stem cell treatment on a patient in
Beijing, China to effectively boost the immune
system to fight the COVID-19 coronavirus.
Immunosuppressants
The University of Southampton is trialling a
new drug developed by UK bio-tech company
Synairgen. It uses the protein interferon beta,
which our bodies produce when we get a viral
infection. Initial results from the trial are
expected by the end of June. Interferon beta is
commonly used in the treatment of multiple
sclerosis. ⬛
16 OH TODAY
OH TODAY 17

RETURN TO THE
FRONT LINE
Former nurses, doctors and healthcare workers were told ‘the NHS needs you’ in a recruitment
drive to support the fight against coronavirus (Covid-19) in March. Retired NHS workers and
those in the private sector have been asked to ‘stand up, step forward and save lives’ to help the
NHS tackle the biggest global health threat in a century. We follow Su, Gill, Sally-Anne and Sally
on their journey.
Right: Su Chantry
working in the NHS
SU CHANTRY
I work as an occupational health manager
at Williams Grand Prix Engineering. I
have a degree in public health nursing
and am registered on part 3 of the NMC
register as a SCPHN Occupational health.
I also have my own occupational health
business supporting the health and
wellbeing of local small and medium
businesses.
My recent work in occupational health
has been focused very much on the public
health and infection risk management of
the Covid-19 crisis, however after the
lockdown and social distancing guidelines
on 23rd March, much of the clinical
facing occupational health work has
stopped. My 15-year career in
occupational health has always been in
the private sector and my NHS memories
are fond but in a long distant past.
There was a call out campaign for clinical
staff to assist the NHS and retired nurses
were called back to nursing. As an active
registrant I felt I had to assist my NHS
colleagues and applied through the rapid
response recall service to work. I think
I’ve sat and held
a scared middleaged
patient’s
hand as he has
wept at the
reality of just
how sick he had
been and just
how thankful he
was to the
nurses and
doctors who
were caring for
him.
many of us in the private sector felt the
same. Four weeks ago, I was fast tracked
back into the NHS and have been
redeployed back onto the wards at the
John Radcliffe to assist my colleagues.
I list my availability weekly and there are
up to 60 shifts per day listed. An hour
before my shift I am allocated to a ward.
This has ranged from general medicine,
orthopaedics, cardiac critical care and
acute respiratory wards. All the wards
have covid positive patients. The hospital
is eerily quiet, no visitors, no outpatients,
the everyday hustle and bustle of a
hospital corridor is silent.
It’s been an enlightening return to the
wards. Each ward I arrive on I feel like the
new girl. I arrive proudly wearing my ID
attached to my Queen’s Nurse lanyard,
but this has to be discarded as soon as I
change into my scrubs. None of the
adornments we nurses like to wear are
allowed – no badges, no lanyards, no
name badges: the infection control
measures strictly applied. I have not
witnessed any shortage of PPE where I
have been working.
We are all veiled in surgical masks and
non-verbal eye communication at two
metre distances has been heightened in
the Covid_19 crisis: I find myself winking
and nodding to convey my positive
willingness to assist. It takes up to 15
minutes to don level 2 PPE and that in
itself is exhausting. Time of dressing is
logged by the senior nurse who allocates
break time on the nurse board to ensure
you do not overtire. Even donning off is
exhausting and time consuming. The
relief to be free of the kit is uplifting, but
the dread of knowing you have to put it
all on again soon is bubbling away while
you try to quench your insatiable thirst in
the break.
The technology has moved on so far from
my traditional days of ward work in the
1990s – that’s been a challenge. But the
nursing process has not changed. On
some wards I have been allocated my own
case load, other wards have reverted to
task nursing, just to ensure that all the
work on the shift gets done.
I have sat for over an hour with one very
agitated patient who was clawing at his
CPAP fighting to breathe; he was fighting
with every ounce of strength he had
against every millilitre of sedation meds
the doctor was giving him. I’ve sat and
held a scared middle-aged patient’s hand
as he has wept at the reality of just how
sick he had been and just how thankful he
was to the nurses and doctors who were
caring for him. I have been chasing my
tail on the relentless observations and
medication list and I have become as alert
as a hawk in watching saturations and
respirations as we battle with the virus,
and to wean a recovering patient
gradually off oxygen. I have dug deep into
my critical care nursing memory to
remember the multiples of acronyms used
in the NHS.
I may not be part of the permanent team
but have shared the highs and lows with
the amazing staff I have shared a shift
with. I leave a gift of funky headbands
made by my children to ease sore ears
from the straps of PPE – its our little way
of saying thanks.
I shower at work, take my food box and go
home to a further home decontamination
regime to reassure my family; they are my
key-workers and are all staying safely at
home.
It’s hard to switch off; as an occupational
health specialist nurse I am well aware of
the impact this crisis will have on mental
health of so many – let alone the nurse
colleagues I am working with. I know
when I return to my occupational health
work this will be a key element of the role
occupational health will have in the
community.
In the meantime, my Queen’s Nurse
lanyard is all set for the next shift. ▶
18 OH TODAY
OH TODAY 19

GILL FURBER
I am used to donning my smart skirt, top
and heels and driving around the UK to
my contracts to provide Occupational
Health. I am a Specialist Nurse
Practitioner (PH) in Occupational Health
and like most of us in OH, my work
towards the end of March had been
decimated as Factories had to close their
doors and furlough their staff. Although I
still had a couple of large Food
Production Companies to support, I
suddenly found myself with excess time
on my hands. I had to make a decision
about whether I spend my time pruning
the roses or answer the email that I
received from the NMC about returning
to the frontline.
A friend who works in Acute Medicine on
the “Front-line”, said that the pressures
were becoming difficult, so the decision
to return seemed the most perfectly
natural thing to do. Prior to leaving the
NHS to work in Occupational Health, I
was an A&E Sister as well as working
within ICU. I simply could not sit at home
doing nothing knowing that my nursing
colleagues were struggling. I involved my
family who were concerned about the PPE
At the end of my shift, I left the ward
exhausted, sad, relieved that I got
through the first shift without any
catastrophes but with a feeling that I had
done something so unbelievably rewarding.
issue, but I reassured them that I would
not put myself in harm’s way.
So, I completed my application forms,
started some “E Learning” and organised
a sort of on- Line induction for myself. I
familiarised myself with the new
abbreviations such as DOL’s and NEWS
and learned as much as I could about
Covid-19. I’m from a time when the notes
were hand-written and observations were
recorded manually so I know the
challenge would be immense.
I joined the Rapid Response and NHSP
Bank Nursing and I was inducted at the
Birmingham Nightingale. I was advised by
NHSP that I would need to bring my own
uniform and realised to my horror that I
did not have one. I knew
our Village WI had been
involved in “Sewing for
the NHS” so I put the
call out on our Village
Facebook site and within
twenty four hours, I had
a set of scrubs, wash-bag, headband and
tucked inside the scrubs was a lovely card
from the WI thanking for me for my NHS
work and the card travels in my rucksack
every time I go to the Hospital.
The night before my first shift on an
Acute Medical Covid ward my dreams
were wracked with images of me being
frog marched off the ward by the
Constabulary into the back of a van with a
blanket over my head for causing untold
chaos on the ward!
Left: Gill Furber in
her scrubs
This could not be further from the truth.
The staff were aware of my years away
from the wards and this did not bother
them. After a whistle stop tour of the
ward, my task was to support the Staff
Nurse for the shift. I was introduced to
the new world of donning and doffing of
PPE. I dropped things, bumped into
everyone, kept getting the donning and
doffing in the wrong order, had to keep
asking for directions to clinical rooms and
the sluice. Gradually I started to relax and
I found myself carrying more technical
tasks including ECG’s. I four Coronavirus
positive gents to care whilst the Staff
Nurse had a break.
The one comment that made me realise
that I had made the right decision was
from a patient whose wife had died the
previous day on another ward,” Don’t
leave, stay with me” he said as I was
about to doff the PPE. So, I did and whilst
I helped him to drink his brew, we sang
some rude songs together, (songs that my
Mancunian Grandfather had taught me as
a child) and he said, “you’re not a posh
SALLY-ANNE EVANS
Following the call for clinical staff to
return to the NHS, I duly did my bit and
applied to the NHSP mid-March 2020. I
had heard nothing further, so on 26th
March I also applied through the NHS
returner’s scheme. They were prompt to
contact me, have a Skype interview, check
my documents and email through the
contract, but then I heard nothing further
until 28th April when they required a DBS
check.
Meanwhile early April, the NHSP cleared
me without having to do any
occupational health checks but
unfortunately there was no trust in my
area; I live in the South West where the
number of cases have been rather
underwhelming in comparison to other
Brummy after all”.
At the end of my shift, I left the ward
exhausted, sad, relieved that I got
through the first shift without any
catastrophes but with a feeling that I had
done something so unbelievably
rewarding.
It is tough and it is sad but really, nursing
is nursing, abbreviations may be a little
like another language and not having to
hold mercury thereover under the tongue
for three minutes is something be
applauded, but the patients are still the
same, worried, scared, poorly and in need
of the type of care that I was taught to
deliver many years ago.
When this is all done and we get back to
something like normal, I will continue
with my Bank Work because there are
always going to be patients who need
someone to sing rude songs to them in
the middle of the night when they are
frightened.
regions. On 10th April I was informed a
local community NHS trust had been
added to the NHSP list, so I contacted the
trust to ask a few practical details such as
what to wear as I didn’t have any
uniform. During the conversation I was
informed I required some clinical
updating which I understood, however,
the trust, didn’t have the present
capability to carry out that kind of ad hoc
training for agency staff. They suggested I
join their bank where it would be done
with other NHS staff, so I decided to
apply via that route. From 14th April I
exchanged over 50 emails, 3 phone calls,
had a Skype interview and did over 10
hours of online training to be offered a
zero hours contract of employment. ▶
Images supplied by contributing authors.
20 OH TODAY
OH TODAY 21

I finally start on 11th May with a clinical
induction, followed by more online
training via Microsoft Teams for Systems,
and then I will join the swabbing team.
During that time the NHSP phoned me 3
times to ask why I wasn’t taking up their
shifts and I had to explain about the lack
of update training. On 4th May the NHSP
sent an invite to apply for a home-based
telephone role for the new clinical
contact case worker. Despite originally
being taken on by NHSP, this role
involved a completely new application
and a re-send of all my documents; I am
now waiting to see if this has been
accepted.
From the call to arms, starting in mid-
March to my first work day has taken 2
months. On
reflection, getting
back to the NHS to
help with the
pandemic has taken
huge effort and
persistence, but I
was determined to see it through. Many
others I know have had the same issues,
so it is not for want of trying. My personal
documentation has been sent via email 4
times, the people at the other end are so
swamped with applicants.Doing
everything remotely for job application is
extremely frustrating, but I look forward
as I take my first steps back into the
“Firm”, though not without slight
trepidation.
Left: Sally-Anne
Evans
SALLY GREENWOOD
I am an OH Travel Health Specialist
working for Roodlane Medical. I found
that I had some spare time on my hands
in the evenings since the lockdown. When
I received the email asking to help the
NHS, I really felt drawn, but
unfortunately due to my personal
circumstances I was unable to.
One evening I had an idea to make some
jewellery angels to donate to the NHS
front line volunteers. Jewellery making is
my passion and I set to work. I delivered
them to the NHS workers and I was so
touched by the lovely thank you messages
from them.
staff who have been struggling to get
them during the crisis. The group were
absolutely fantastic and they have been
so supportive. My sewing skills have been
put to good use and I have delivered my
first order to a very satisfied customer.
If you like sewing or you are an NHS
worker and you are searching for scrubs
visit directory of Scrub making hubs.
Both my jewellery making and sewing
have really helped me through this crisis.
⬛
Below: Sally
Greenwood’s
jewellery being
received by NHS
workers.
I also saw an advert for a local scrub
group who were looking for volunteers to
sew scrubs. I hadn’t sewn for some time
but I felt I might improve my sewing
skills whilst helping at the same time.
The “Scrub Hubs” are a network of
voluntary community groups who love to
sew and make scrubs to order for NHS
22 OH TODAY
OH TODAY 23

Feeling
Furloughed.
Ilove my job. I have been in OH since
1996 and, while the actual practice
may have changed over time, the
purpose has not: supporting and advising
employers and employees to work safely
and healthily. Its who I am.
So, when I was furloughed (and I was
expecting it), I wasn’t upset. I had seen it
coming and knew that it wasn’t going to
be permanent. I had already volunteered
with the NHS when they had asked for
help and I had also contacted local
services like the GP surgery, churches,
local parish council etc. to let them know
I was healthy, keen and available for
whatever they needed. I had knocked on
my neighbours’ doors the week before
and gave them my number in case they
needed anything – we live in a very rural
place and the hamlet has six houses. I had
a different sense of purpose and thought I
had prepared myself.
Seven weeks on and I have yet to have a
call asking for me to do anything. I have
no sense of purpose. I wake up in the
morning and get up only because my two
dogs tell me its time to get up. Sometimes
I persuade them to settle back down but
more often than not they want their
breakfast. After that I make a cup of tea
then wonder what I can do as the usual
morning activities only takes a very small
part of the day. I have not particularly
hungry as I’m not really using much
energy and I’m finding it hard to fall
asleep as I’m not tired from using my
brain or my body. I’ve started to worry
asking myself – could I be depressed?
Unlikely, I tell myself as I quickly go
through the PHQ/GAD in my head. I’ve
just lost my sense of purpose – without
my job what use am I? Webber (2020)
comments that 45% of people admitted to
feeling anxious, stressed, isolated, bored,
unappreciated and sad so I don’t feel
alone in my experience. Webber also says
“how leaders respond to this modern-day
crisis is also determining the welfare of
their teams – they need to influence the
ability of their people to keep going and
stay motivated under very difficult
circumstances” and fortunately my
leaders have responded well.
My team lead has arranged for a catch up
each week via zoom where I get to see my
colleagues. This is lovely but I actually
feel jealous that some colleagues are still
working, because they are doing face to
face work (how bizarre is that).
Everybody, furloughed or not, appear to
be coping OK. But then I probably seem
ok to them too – which make me wonder
if they really are all as ok as they seem.
Jim our CEO has given us updates so far
and it has always been a positive
message. I knew I just needed to hold on,
keep my skills up to date and keep myself
occupied. My employer arranged training
sessions and classes via Zoom, which I
have signed up for; but then I
immediately worried that I wouldn’t be
any good – my brain is no longer in ‘work
mode’. I have undertaken four training
sessions so far and have found them very
that my work skills and knowledge are
becoming obsolete and that when it’s
time to go back I won’t be any good. In
fact, I feel I am so useless that I’m not
even any good for voluntary work!
With my professional head on, I keep
useful. They have also helped to fill in the
time but finding the motivation to get
stuck in can be really hard some days.
I’ve taken to writing a list of things to do
each morning. I even write down what to
eat and when, to help keep the portion ▶
24 OH TODAY
OH TODAY 25

sizes down, as I’m not as active as I
normally am. I don’t let myself go to bed
at 7pm because there is nothing else to
do. I maintain communication with my
grown-up children every day and do
FaceTime with my granddaughter which
is fun; at the age of three she can take the
phone from her mum and we have a play
– she has adapted so well thanks to her
amazing parents. I list things that ‘need’
to be done even though they are so small,
like groom the dogs, sweep the floors,
water the plants, complete training/
homework – ticking each of those off has
given me a sense of achieving something.
So, with this new 'way of ‘working’ I am
finding a new purpose – keeping myself
ready to step back into the job I love
when I am asked to return. It’s a different
purpose but at least I’ve found one. I still
feel unsettled and worry unceasingly that
my skills are so dented that I won’t be as
useful as I was. But I keep telling myself
that once back I’ll slip straight back into
it but with improved skills because I’ve
been given this time to work on it.
It’s given me an insight into the effects
that employees experience from being
absent for any length of time whatever
the reason. I now understand, in a small
way, that sense of being deskilled and the
awful feeling of losing confidence in
being able to do a ‘proper’ job. The advice
I will give for a supported return to work
plan for the manager to consider will
include the hours someone goes back to,
to increase the work stamina but also the
opportunity to engage with in-house
training or working with a mentor for a
short period of time - subject to what is
operationally feasible - in order to
address that sense that they feel deskilled
from lack of use and the dent in their
confidence that may require addressing.
⬛
A Day in the Life of a
Flu Outbreak
A retired member’s experiences of nursing in the late 1960s.
Iwas a student nurse in the late 1960’s
early 1970’s in Glasgow. It was very
different back then. Most of the
nursing staff were student nurses with a
backbone of trained staff supported by
nursing auxiliaries. There were no male
nurses in the city at all. Trainee nurses
lived in the nurses home for first year, or
two then you could move out but you had
to be local. You could get engaged but not
married without Matron’s permission.
There was a very small and basic ITU and
a bigger CCU. Heart disease being what it
was in Glasgow.
Students had to do night duty, but
fortunately, I loved it and spent quite a
long time on nights to balance out
colleagues who struggled. Night shifts
were, on the whole, manned by student
nurses, second and third years with two
auxiliaries per ward with up to 30
patients. Night Sister would be on duty to
cover the whole hospital. Surgical wards
took turns at being “ receiving ward” or “
surgery ward” and some nights it got
quite lively trying to keep on top of all the
drips and post op obs.
So a hospital mainly staffed by 18 and 19
year olds with mature auxiliaries
providing support. They were invaluable!
Medical Wards were generally a bit
quieter but until ITU opened we got all
the overdoses too, most were put on
forced diuresis and needed a lot of
watching.
Glasgow had large numbers of smokers
with chest issues and major heart disease.
When they started measuring cholesterol
it was not elevated till it was over 8 and
12 was not unusual.
Medical wards were inundated with
admissions. We were situated in
Nightingale wards with beds in the day
room, beds up the middle of the ward and
on one night a bed in the store room. As
is usual on nights we were losing people
in the early hours, sometimes three or
four in a night. We were used to lose
patients, but nothing like this.
Porters used to come up with the special
trolley and take the body to the mortuary
as usual, but at this time they just left
trolleys out in the corridor.
At times we had double-decker bodies.
Staff used to take bets on who would lose
the most, and although not in good taste
the dark humour got us through.
I remember there was no such thing as
PPE. There was still a Fever Hospital for
anything considered a serious threat to
public health but things like flu you just
got on with.
The plan was to try not to have
admissions overnight to medical but at
this time it was not working. The
Receiving ward went out of the window
too, it was a case of who had a bed,
normally, recently vacated!
One particular time we had a bad flu
outbreak, could have been National, I
don’t recall.
One particular night shift I admitted a
middle aged lady at about 1am
accompanied by her husband. She was ▶
26 OH TODAY
OH TODAY 27

Staff used to
take bets on
who would lose
the most, and
although not in
good taste the
dark humour
got us through.
heavy smoker with bronchitis and now
flu. I eventually got her settled and on
O2. I reassured and chatted to husband,
he came back into the ward to see her
briefly to say goodbye and reassured her
he would be back the next day. We still
had very rigid visiting hours.
She was confused and upset and managed
to wake half the ward, then she dislodged
her oxygen, had an anoxic attack and had
a very good attempt at strangling me. The
SHO was called and he prescribed a mild
sedative. We had several very ill patients
keeping us on our toes that night. In the
meantime I assisted with a lumbar
puncture with the SHO on another lady
who had very odd symptoms and was
worrying me. I had bleeped him to come
and review her earlier.
About 5am my first lady took a turn for
the worse, She probably arrested but
despite having the SHO on the ward to
help she just gently slipped away. There
were no crash teams in those days and I
don't think it would have made a
difference.
We started hourly checks as quite a few of
our patients just slipped away in their
sleep, heating was switched off overnight
and low temperatures did not help.
The Night Sister phoned the husband.
I did the report handover to the morning
staff and on heading home, I got into the
lift rather than take stairs and husband
was in it.
He just looked at me, said: “ You didn’t
save her!” He burst into tears. We
managed to get into the corridor after
what seemed ages and we had a cry
together.
They were a couple with no children and
were devoted to each other. He knew she
was ill but was confident we could “make
her well again”. We talked for a good
while and then I took him to ward.
In those days too much contact with
relatives was frowned upon so I slipped
away before being reprimanded.
I have never forgotten this night, and
although as nurses we lose many over the
years, this is the one that stayed with me
and I can still see his face. Not in a bad
way, but I remember it still.
There was no support for staff in those
days, or relatives come to that. You were
just expected to get on with it. We were
close as a student group and supported
each other.
It was a very different world to today, my
mother was a nurse as was my
godmother, what I experienced was
familiar to them too.
Just as an aside my other lady, who had
the lumbar puncture, died that day too.
On post mortem examination she was
found to have had such severe kidney
infection in both kidneys, they had
basically disintegrated. I’m not sure what
they put down as cause of death, but I
would assume kidney failure!
They ran out of mortuary space in all the
hospitals at this time and hired chiller
lorries from Christian Salvesen to store
the bodies. Crematoriums put on extra
shifts to try and cope with backlog. Grave
space was at a premium too. The City of
Glasgow did not want new graveyards
opening up just for Flu.
I’m quite convinced most death
certificates were signed as complications
of chest disease without any further
investigation.
We came out the other side and life
continued, as it does, but you never lose
sight of the humanity in all of this.
Memories of times past remain with me
as vividly as when they happened when it
comes to some of my patients. ⬛
INTERVIEW
Lynda Bruce
WRITTEN BY LYNN PRATT, EDITOR
I had the pleasure of catching up with Lynda Bruce,
Specialist Community Public Health Nurse (OH)
and Fellow of Royal Society of Public Health and
Associate Fellow of the Higher Education
Academy. Lynda lectures on the Occupational
Health course at the RGU and volunteers her time
to help support members through the iOH Support
Line.
I am keen to
give back to a
career that has
offered me so
many benefits
which is why I
am happy to
volunteer for
the helpline
with iOH.
How did you get into OH?
I found Occupational Health , as I am sure
many people do , by accident when
working for a nursing agency . I was
assigned jobs with an OH provider owned
at the time by Aberdeen University and at
the same time I was also assigned to work
with a large oil company as their onsite
Nurse. Both roles were so different to my
previous nursing experience – which had
been in CCU and I really enjoyed the
interaction with mainly well fit people
and the level of autonomy. At the time I
was a widowed mum of 3 very young
children so the Monday to Friday 0900-
1700 hours were great.
Both organisations offered me a job and I
chose to accept the position with the OH
company. They funded me through my
OH education starting with an innovative
four week course at Aberdeen University
called an Occupational Health Practice
Nurse Course validated by the RCN.
What are you currently
doing?
I am really lucky in my current work
situation. I set up a Private Limited
Liability Company in 2005 –I am the
owner and Managing Director with a
fabulous team –we are a nurse led
organisation and have a successful
operation in Aberdeen where we do our
best to practice what we preach especially
with regards to team working in a
supportive environment. Then a few
years ago I was asked to work at RGU as a
temporary lecturer in Occupational
Health on the distance learning course. I
was already a Practice teacher so had
some previous exposure to the
curriculum.
I am now a part time lecturer on the
course working with my two full time
Colleagues two days a week. I really enjoy
the academic role- I have terrific
colleagues and supporting the students to
develop their OH practice is a great
privilege.
I am getting towards the end of my career
and am keen to give back to a career that
has offered me so many benefits which is
why I am happy to volunteer for the
helpline with iOH - Association of
Occupational Health and Wellbeing
Professionals. ▶
28 OH TODAY
OH TODAY 29

30 OH TODAY
You wear several OH “hats”.
How do you organise your
time?
Time management is central to my daily
life –I use a timer a lot and keep track of
what I do carefully so I can be sure I give
every aspect of my life at work and at play
the time it deserves. I am also a keen list
maker –I start every day with a list and
get a great deal of pleasure from ticking
off when the task is completed!
Who and what has inspired/
guided you most?
I think that being a nurse is at the core of
being in Occupational Health- I am
inspired by all the practitioners I have
worked with in the past and now. I also
continue to really enjoy being able to
help and support patients, newcomers to
OH and OH students.
In today’s world we often speak about
random acts of kindness –I feel these are
daily occurrences with the people I work
with every day and this coupled with my
nursing ethics are guiding principles.
What inspired you to start
your own business?
In my role working for the Occupational
Health Company I became the Chief
Occupational Health Nurse –but I also
became the Business Development
Manager. It seemed to me there could be
ways to organise a business that resulted
in a better work environment and so
started to look at how to do so in 1999-I
then went to work for a terrific
organisation that is now a leading private
hospital and they gave me the freedom to
set up Occupational Health business from
scratch – the organisation actively
practised a quality system called Deming
Management(The Deming cycle is a
continuous quality improvement model
which consists of a logical sequence of
four key stages: Plan, Do, Study, and Act.)
which chimed well with my aspirations.
When that branch of business was sold to
a larger OH company, I decided to set up
my own Company-a decision I have never
regretted.
What are the challenges of
running your own business?
The biggest challenge is currently
creating organisational resilience so we
can survive and perhaps grow during
Covid 19. Early indications are positive.
My company is supported by professional
support –our Financial Director is a
Chartered Accountant; our Contracts
Director is qualified in Law and Contracts
and our Operations are directed by a very
experienced administrator. The
professional team know they are trusted
and valued, and we strive to work
OH SHOULD ALSO BE THE LEADERS IN HELPING OUR
INCREASINGLY DIVERSE WORKFORCE TO STAY IN
WORK AS LONG AS THEY WANT TO AND HELP ENSURE
THEY ARE NOT HARMED IN ANYWAY BY WORK.
collaboratively. We all know we can work
from home whenever feasible not just
presently.
Where do you get support
from?
All my colleagues in all my work areas,
family, and professional networking.
Do you have any advice for
those considering going into
OH or considering further
academic study?
Congratulations on starting a career in
Occupational Health-I think it is a
speciality that can only grow and develop.
I see a bountiful future for OH if we
continue to move forwards as a
group. My OH lecturer at Queen
Margaret’s Edinburgh taught us all
that OH is full of characters and
this remains true –OH is home to
many diverse characters that bring
their passion to the speciality.
How do you see the
future of OH?
I think the future of OH is hopefulwe
should be at the forefront of
supporting employers with
sickness absence and it may be that
will include OH nurses being the
person who is most involved-we
understand the work place and the
people whose health impacts their
work ability .
OH should also be the leaders in
helping our increasingly diverse
workforce to stay in work as long as
they want to and help ensure they
are not harmed in anyway by work.
Of course this utopia is dependant
on OH finding a voice based on
concord and the good of OH rather
than any other concerns.
How does doing
voluntary work for iOH
and the support line fit
with your other OH
“hats”?
I have been volunteering with iOH
for about a year. My other hats sit
very well with being able to
confidentially support colleagues.
The issues raised to date have
mainly been either commercial
activity based or ethical dilemmas.
My experience means I do have the
opportunity to offer alternative
view points for consideration that
may help people to move forwards.
⬛
Obituary - Lynn Faulds Wood
iOH are saddened to learn that Lynn Faulds Wood has died after
suffering a massive stroke. Lynn was a patron of the Association
of Occupational Health Nurses (AOHNP) from 2000-2007. She
spoke at a number of AOHNP conferences regarding the
importance of the awareness of Bowel Cancer and was a great
advocate for Occupational Health.
Lynn worked for the Daily Mail, The Sun and moved to breakfast
TV, before making her mark on Watchdog as a consumer
journalist working alongside her husband John Stapleton. She
contributed to a programme “Doctor Knows Best” and in an
edition of World in Action she achieved the programmes highest
audience of 10.3 million viewers.
Lynn was diagnosed with stage three bowel cancer but later
recovered. Following this she set up the charity, Lynn’s Bowel
Cancer Campaign. She identified that the workplace, schools and
hospitals provided the ideal setting to support the promotion of
healthy bowel awareness to a large group of people. She worked
with members of the association and OH professionals to tackle
this difficult area.
Ann Ramsey -current BP UK Health Manager and ex AOHNP
Regional Director, comments that Lynn provided Occupational
health Nurses with the momentum to promote relevant cancer
prevention activities. Her enthusiasm and passion were inspiring,
and we related to her on a number of levels.
She was also notable for rejecting an MBE in 2016 saying the
honours system needs to be dragged 'into the 21st Century'.
Jo Henderson-Tchertoff, a former campaigner worked with Lynn
on “Lynn’s Bowel Cancer Campaign” paid tribute to her saying
that she was an amazing lady. She was funny, kind, and generous
and a real campaigner for so many people. She saved so many
lives by being so passionate about her cause. She really will be
sadly missed. ⬛
OH TODAY 31

Hygiene in Spirometry
Recent Findings on Reducing the Risk of Cross-Contamination
Sponsored by
Spirometry testing is a key
component of any Occupational
Health surveillance program.
Practitioners know that a subject is asked
to carry out maximal inspiratory and
expiratory breathing manoeuvres into a
spirometer. The majority of spirometers
used in occupational health today are
flow-sensing spirometers which are open
circuit systems. This means that all the
expired air from the test subject goes
through the flowhead and out of the other
end, with very little resistance in
between.
Without the use of a filtration barrier,
risks of cross-contamination increase
dramatically. The term ‘crosscontamination’
refers to the process by
which bacteria or other micro-organisms
are unintentionally transferred from one
object to another, with harmful effects.
With no filtration barrier in place there is
nothing to stop aerolised droplets
carrying bacteria and potentially harmful
viruses from entering the testing
environment. Now, with the outbreak of
COVID-19, the role of these aerosolised
droplets in the transmission of viruses
has increasingly been recognised.
The use of a Bacterial Viral Filter (BVF)
for each test subject has long been
recommended during spirometry
testing¹ , ² , ³. This type of filter has been
shown to significantly reduce the risk of
cross-contamination and patient
infection during testing. Earlier this year,
Professor Colum Dunne and colleagues at
the University of Limerick and Nelson
Labs in the USA rigorously tested
Vitalograph BVFs to assess their
effectiveness in preventing bacterial or
viral transfer to and from spirometry
devices.
Unlike standard barrier filters which trap
expectorated matter whilst allowing
viruses and bacteria to pass through, the
Vitalograph BVF uses electrostatically
charged material to trap expectorated
matter plus bacteria and viruses. This
creates very effective protection against
cross-contamination. The report
summarises the work completed which
verified and highlighted that the
Vitalograph BVF is effective in preventing
cross-contamination.
Testing Procedure
Nelson Labs tested both new Vitalograph
BVFs and BVFs that were over 7 years old
to verify that they continued to function
as specified for the entirety of their shelf
live.
The BVFs were tested for bioburden (the
number of bacteria living on a surface
that has not been sterilised) crosscontamination
prevention in a laboratory
environment. The efficiency of the filter
was tested using a Vitalograph spirometer
flowhead (found on device models such as
Pneumotrac, ALPHA, ALPHA Touch and
Compact Expert spirometers) to
calibrated flow rates ranging at; low (< 55
L/min), medium (between 55 L/min – 750
L/min) and high (> 750 L/min) with
highest tested flow rate being 960 L/min
(well in excess of what a subject would be
expected to achieve in a clinical setting).
Left: A diagram of
Vitalograph’s
Bacterial Viral Filter
Above: a Twitter
thread from Prof
Dunne
(@ProfColumDunne)
about Vitalograph
BVFs.
Right: Vitalograph’s
BVF Certificate of
Cross-Infection
Efficiency.
The aim being to determine whether the
Vitalograph BVF protects against crosscontamination
at various flow rates.
Results
The great news was that the results
showed >99.999% effectiveness for
prevention of microbial transfer to
equipment. The Vitalograph BVFs also
reduced potential transfer from
equipment to user to a level below levels
of detection. When a new BVF is used for
every patient, the interior of the device is
also protected meaning that only exterior
surfaces require cleaning with a 70%
isopropyl alcohol impregnated cloth. The
findings were echoed by Professor Dunne
on social media in light of the on-going
pandemic of COVID-19 when he
recommended the use of BVFs during
spirometry testing to reduce the risk of
cross-infection.
The report can be viewed on the
Vitalograph website 4 .
Based on these studies, the Vitalograph
BVFs carry a Certificate of Cross-
Infection Efficiency.
Summary
Vitalograph BVFs, when used in
conjunction with our devices, provide an
efficient solution giving better than
99.999% protection from bacterial and
viral cross infection. They provide a
significant level of protection for the
subject, the device and the user against
cross contamination during spirometry
manoeuvres. Along with recommended
cleaning the exterior of the spirometer
flowhead using a 70% isopropyl alcohol
impregnated wipe between subjects, this
will also help in reducing the risk of the
spread of COVID-19 and other bacteria
and viruses between subjects and the
operators during spirometry testing.
References:
1. Graham, B., Steenbruggen, I., Miller, MR., et al.
(2019). Standardization of Spirometry 2019 Update.
An Official American Thoracic Society and European
Respiratory Society Technical Statement. Am J
Respir Crit Care Med Vol 200, Iss 8, pp e70–e88
2. Levy, ML., Quanjer, PH., Booker, R., Cooper, BG.,
Holmes, S., Small, IR. Diagnostic Spirometry in
Primary Care. Proposed standards for general
practice compliant with American Thoracic Society
and European Respiratory Society
recommendations. Primary Care Respiratory Journal
(2009); 18(3): 130-147
3. Ward. S. and Cramer, D. Bacterial/Viral Filters in
Pulmonary Function Departments. Access online;
http://www.wales.nhs.uk/sitesplus/documents/861/
bacterial%20viral%20filter%20info.pdf
4. Vitalograph Cross Contamination Report for
Bacterial Viral Filters. Accessible online at; https://
vitalograph.co.uk/downloads/view/284 ⬛
Images supplied by Vitalograph.
32 OH TODAY
OH TODAY 33

Supporting our clients and caring for
ourselves: brief guidance By Libby Morley
It is important that we acknowledge the possible
impact on the mental health of workers across all
sectors including ourselves as providers of
Occupational Health. It is also important however
that we do not medicalise what is likely to be a
normal reaction during these most unusual of times.
Having a listening ear and a chance to express our
feelings can be enough to manage our emotional
response to these unprecedented times.
That said, we are undoubtedly facing a rise in many of
the risk factors that can lead to suicidal thoughts and
mental ill health such as unemployment, financial
crisis, bereavement, depression, alcohol and drug use,
guilt and shame all of which could be especially
pertinent during and after this pandemic.
It will be helpful for us to familiarise ourselves with
local support services, national organisations and the
details of what Employee Assistance Providers offer,
not only to direct employees but to their wider family.
Further, OH practitioners could make themselves
aware of any sector-relevant charities that provide
wellbeing support and in some cases support during
financial hardship, for example:
• https://www.lighthouseclub.org/ for the
construction sector
• https://www.veteransservicelse.nhs.uk/ for
veterans
• https://www.firefighterscharity.org.uk/how-wehelp-2
for firefighters
• https://www.retailtrust.org.uk/about-us for retail
and supporting services
• https://www.hospitalityaction.org.uk/ for the
hospitality sector
• https://www.bwcharity.org.uk/about-us/oursupport-services
for current and former bank
workers
For NHS staff, the NHS has partnered with Headspace,
UnMind and Big Health to offer a suite of apps for no
charge to assist staff with their mental health. The
apps offer support in everything from guided
meditation, tools to battle anxiety and help with sleep
problems.
Regarding support for day to day management by OH
practitioners in their role, it is imperative that any
information referred to is from a current and valid
source for example the British Government, the
World Health Organisation and Public Health
England. We are also likely to benefit from increasing
our knowledge on common mental health challenges
such as anxiety, panic-attacks, depression, and
suicidal thoughts. iOH members can access
knowledge leaders on a variety of OH related topics
and we encourage you to approach any member of the
board to explore this further.
Regarding caring for our own mental fitness, let us
connect with our peers via Facebook, JiscMail or other
virtual platforms that enable regular opportunities to
offload and share expertise. A balanced approach to
exposure to social media and the news is, I find,
crucial. I aim to have a specific time frame in which to
access information on the various social media and
news platforms and have personally felt overwhelmed
with the multitude of information combined with the
sadness of much of what I read. Members are
welcome to contact a confidential and supportive
listener by emailing me (Libby Morley) via email in
the first instance at
libby@mindshiftconsultancy.co.uk.
Lastly, I think it is helpful to be reminded of and to
implement the actions described in the Five ways to
Wellbeing, an evidence-based guidance tool that
supports resilience. Obviously, we may to be a little
creative in bringing some of them to life during the
current restrictions! Here is the link
https://www.nhs.uk/conditions/stress-anxietydepression/improve-mental-wellbeing/
⬛
Join iOH Today.
Only £10 per year
Free Student Membership
Member benefits include:
• Quarterly OH Today Magazine, plus access to all back
issues
• Members’ support line, for free one-on-one
confidential advice
• Professional networking events throughout the year
• Exclusive discounts and deals on OH events, software
and more
ioh.org.uk
34 OH TODAY
Student membership free for first year, then £10 a year
OH TODAY 35

The course is for NMC Registered Nurses who want to gain a
specialist qualification in Occupational Health Nursing. If you have
either a Diploma, Advanced Diploma in Nursing Studies or Degree,
the course can be studied at either BSc (Hons) to top up your
qualifications or MSc level for those that are ready to progress.
University of Derby
Kedleston Road
Derby
DE 22 1GB
Applications are now open
Neil Loach
Senior Lecturer and Pathway Lead for Occupational Health
Core Modules:
• Evidence Based Project
• Leading for Quality
• Principles of Practice Assessment
• Public Health and Health Improvement
BSc (Hons) / PG Dip
SPECIALIST COMMUNITY PUBLIC HEALTH NURSING
in Occupational Health
Option Modules:
CONFIRMED:
Course going ahead in
September 2020
• Ergonomics in Practice
• Principle of Long Term Conditions Management
• V100 NM Prescribing
• V300 NM Prescribing (2 Modules)
Duration: 1 year Full Time or 2 Years Part-Time
Apply: derby.ac.uk/applyonline